By Shamsydeen Badmus

A new study published in this month’s Bulletin of the World Health Organization (WHO) suggests that neither wealth nor poverty is driving the spread of HIV and AIDS in Africa. The study’s findings challenge widely accepted views that poverty fuels HIV. The researcher, Justin Parkhurst of the London School of Hygiene and Tropical Medicine, carried out a comparative analysis of HIV and wealth data from 12 sub-Saharan African countries with generalised epidemics. Parkhurst found several different patterns for the relation between income level and HIV prevalence, varying according to country, time, gender and education level. His findings indicate that prevention campaigns targeted at specific risk behaviours should be stronger than “one-size-fits-all” models which do not account for the complex relation between all those factors.

Seyi Oduyela/Washington, DC

The United Nations-backed Global Fund announced yesterday that it has secured 2.4 billion US dollars to support projects that fight AIDS, tuberculosis and malaria in low-income countries over the next two years. These three diseases are estimated to kill more than four million people every year. The Global Fund also said that a 216 million US dollar pilot programme to reduce prices for effective malaria medicines will go ahead in nine African countries and Cambodia. Researchers at an international malaria conference in Nairobi earlier this month had revealed that almost one million people die from the disease each year because they cannot afford the most effective treatment available.

USAID-Funded Project Increases Access to HIV Services in Uganda

By Seyi Oduyela/Washington, DC

 A new report published by the Alliance describes how Alliance Uganda implemented the three-year USAID funded project, Expanding the Role of Networks of People Living with HIV in Uganda (the Networks Model project).

The report outlines the background, achievements and lessons learned during the start up, implementation and close out of the project, which ended in July 2009. It aims to support learning across the Alliance’s programmes and the wider HIV response.

The project’s main objective was to use networks of people living with HIV to increase access to HIV and wrap-around services. The project did this by building the capacity of groups of people living with HIV (PLHIV groups) to link communities and people living with HIV with their local health services. It also gave people living with HIV an important role in supporting the delivery of HIV services in health facilities and the community.

During its three-year life, the project dramatically increased access of people living with HIV to prevention, care and support services. Over 1.3 million people accessed HIV services through the project.

Emilly Katamujuna, Programme Manager of Alliance Uganda commented: ‘We often hear arguments from policymakers and donors that community based organizations are not able to deliver national scale services that will sufficiently impact the epidemic. This report documents how the Networks Model Project proved that a coordinated community based response can have an impact at a national level.’

The project originally started in seven districts of Uganda but rapidly expanded to cover 40 districts nationwide, and was replicated in a further 12 districts by Alliance partners.

An external evaluation of the project undertaken by JHPIEGO on behalf of USAID found that the Network Support Agents – trained people living with HIV (PLHIV) to work as community volunteers – was one of the most successful components of the project:

“The [NSA’s] have been able to mobilize PLHIV to utilize existing services, including health facility-based services and wraparound services provided by community-based organizations (CBOs) and non-governmental organizations (NGOs). They compensate for a shortage of staff at health facilities, where they direct and counsel clients. They also play a critical role in tracking and following up clients.”

Monica is a Network Support Agent for Namungalwe Village, Iganga district in Uganda. The impact of her work is clearly described by one member of the community who wished to remain anonymous: ‘Monica has been of great support to me and my husband with regard to adhering to treatment and I am doing well. She has supported us to disclose to our parents and my brother our HIV status because most of our relatives initially thought that it was witchcraft. Disclosing has helped us to get care and support from the family.’

Ban Ki Moon, UN Secretary-General

 

United Nations Urges HIV Travel Ban Lift

Seyi Oduyela/Washington, DC

United Nations Secretary General Ban Ki-moon has urged countries worldwide to remove travel restrictions for HIV-positive people. The call comes after US president Barack Obama announced a decades-old US travel ban on HIV-positive non-US citizens would be officially lifted today. HIV-positive visitors will effectively be allowed entry to the US from early 2010. The UN has hailed the decision and urged other countries to follow the example. South Korea, China and Ukraine are some of the nations already considering the suspension of similar restrictions, according to UNAIDS. Human Rights Watch also welcomed the announcement, stressing that travel or residence restrictions on HIV-positive people are discriminatory, violate fundamental rights and impede effective responses to HIV by fostering misinformation and stigma.

By Adebayo Somuyiwa

Almost one million people die from malaria every year because they cannot afford the most effective treatment available for the disease, according to research released today. The findings from a study of six sub-Saharan African countries and Cambodia were presented during an international malaria conference in Nairobi. Artemisinin combination therapy (ACT) prices can reach up to 11 US dollars, compared with just 30 cents for older and less effective drugs. The director of Populations Services International Malaria, Desmond Chavasse, said full ACT treatment can cost up to 65 times the daily minimum wage in some African countries. Chavasse warned that the treatment’s presence in public health clinics can be as low as 20 per cent.

By Tayo Adelaja

CiSHAN, an Alliance Linking Organisation in Nigeria, has been playing a key role in advocating for a law to protect people living with or affected by HIV.

An estimated 2.6 million Nigerians are living with HIV. These people have no law to protect them from losing their homes or jobs, or being mistreated by health workers, because of their status.

The need for appropriate legislation and the speedy passage of an anti-discrimination bill through Nigeria’s National Assembly became clear following CiSHAN’s stigma and discrimination project supported by the Global Fund (Round 5). In this project, CiSHAN provided its member organisations with training on reducing stigmatisation in society, using a community outreach model.

Working in partnership with the National Agency for the Control of AIDS (NACA), CiSHAN has succeeded in putting a stigma and discrimination bill before the National Assembly and is now waiting for it to be ratified. This would be an important victory in a continuing battle.

“Laws alone are not sufficient to address these issues,” says CiSHAN’s Executive Secretary Ayo Ipinmoye. “The fact that we have a rule or laws that are not being implemented is not the fault of the law but that of the people who are supposed to implement the laws.

“The onus is now on us as civil society groups to make sure these laws are given muscle and teeth. But in the situation that we are now, there is nothing that criminalises some of these crimes and that is very important. Having a law is important, as a first step.”

Accordingly, CiSHAN have not only focused on advocacy work at government level. The organisation’s Human Rights specialist Jumai Danuk has been leading community mobilisation and sensitisation efforts to ensure the general public are aware of their rights and the efforts undertaken to enshrine these in national law.

The number of HIV-positive people receiving antiretroviral (ARV) drugs has increased tenfold in the past five years, a United Nations report has found. More than four million people in low and middle-income countries were accessing the treatment in 2008, according to the report by the World Health Organization, the United Nations Children’s Fund and the Joint United Nations Programme on HIV/AIDS. However, this figure still represents less than half the number of HIV-positive people who need ARV therapy. The report also found significant increases in HIV testing and access to medicines that prevent mother-to-child infection.

By Tayo Adelaja

Community-based access to drugs for hemorrhages and infection could significantly prevent maternal deaths in Africa, a new paper by researchers at University College London has found. The researchers developed a mathematical model to estimate the impact of providing misoprostol drugs, which are used to induce labour and treat miscarriages, and antibiotics to community health workers. They argue this community-based strategy is crucial for women who have no access to skilled health attendants or well-equipped facilities. This approach would also be complemented by interventions to strengthen health systems. More than half a million women die every year from complications during pregnancy or childbirth. Ninety per cent of these deaths are in Africa and Asia, according to the United Nations Population Fund.

ZIMBABWE

By Thulani Mpofu

Zimbabwe’s farms have long been in the news for the government’s controversial programme of settling black farmers on white-owned agricultural land. But risky sexual behavior which can fuel the HIV epidemic is emerging as a major problem in the countryside. Death rates are high, and as one farm supervisor says, ‘who will do the menial tasks?’

It is their favourite – and only – rendezvous to socialise over drinks on this sprawling cattle ranch in the Fort Rixon area, 160 km east of Bulawayo town.

This blazing October Sunday is no exception. It’s their free hour, and farm labourers have gathered at their local beer outlet – a nondescript, low-lying, green shack – drinking opaque beer and playing draughts.

These days, umkhumbi, a home-brew made from fermented marula fruits is the popular drink, owing to the spiraling price of bottled beer.

Gathered in small mixed groups of men and women, in the shade, they share the potent brew, passing the gourd around for gulps.

“This place used to be busy in the 1990s. There were many of us here then,” said Sipho Njobvu, 56, the farm foreman, sitting with colleagues in one group.

“But now there’s just a few of us left.  Some of our colleagues have left the farm and others are now late” – meaning they are dead.

Njobvu does not know the cause of their deaths, but says most were diagnosed with tuberculosis (TB) before wasting away and dying.
Of those that remain, some are too frail to perform menial farming chores.

“As the foreman, I’m the one who looks at their requests for time-off, so I know who is feeling well and who is not. We have had about six deaths this year alone. If it is AIDS, it has finished us,” he said.

A family man of Zambian origin, Njobvu knows about AIDS, and knows that condoms can minimise HIV-infection.  But he says there is no programme to issue condoms on the farm.  

He also knows – as does the government – that if the mortality rate on the farm continues there is bound to be a major labour crisis soon.

“Work here is tough. I cannot assign a frail person to dig up a pit. I send such people for lighter jobs, like rounding up cattle.  But who will do the menial tasks?”

The Farm Community Trust of Zimbabwe (FCTZ), a non-governmental organisation that assists farm workers, estimates that before the land reform process was launched by the government in 2000, between 320,000 and 350,000 agricultural workers were employed on commercial farms owned by 4,500 white farmers in this southern African country. Their dependents numbered around two million, or about 15 percent of the population.

FCTZ director Godfrey Magaramombe acknowledged that current health strategies tend to ignore farm labourers, resulting in a high prevalence rate of HIV and AIDS on farms.

“Traditionally, commercial farms and mines had the highest rate of HIV and AIDS cases in the country,” he said.
“Now, there has been a noticeable decrease, reflecting the general national scenario. However, the incidence remains high on farms and mines when compared with other locations.”

Zimbabwe’s HIV prevalence rate has been declining over the past few years, but remains one of the highest in the world. It has dropped from a high of about 24 percent in 2003 to about 18 percent in 2005 owing to increased condom use, behaviour change and greater awareness of the disease.

But poverty, illiteracy, ignorance, unemployment, lack of health facilities and high mobility of populations are fuelling HIV and AIDS on farms, Magaramombe said.

“HIV and AIDS are driven by poverty which is endemic on farms because of poor wages,” he said.

“Mobility is very high on farms as workers tend to leave their homes for jobs, some of them seasonal. There is also the question of early and serial marriages – girls on farms tend to get married early and by the time they turn 21 they would have married and broken up with four or five men.”

Because of lack of jobs, he added, girls often engage in casual sex with multiple partners, especially supervisors, to secure employment, thus increasing their risk of contracting HIV.

Most farms do not have schools, and literacy levels are low. “A significant amount of prevention and treatment programmes come in written form and if you cannot read, it limits your ability to comprehend the messages,” Magaramombe added.

Mitigating the impact of HIV and AIDS among farm workers is a huge challenge to Zimbabwe’s agrarian economy. Official statistics show that about 70 percent of the country’s approximately 13 million people depend on agriculture, which provides more than 60 percent of raw materials used in the manufacturing sector.

According to Dr Owen Mugurungi, national co-ordinator of the HIV/AIDS and Tuberculosis programme in the Ministry of Health and Child Welfare, the HIV prevalence rate on farms and mines is always higher than the national average.

“When the national average was at 24 percent, on farms, the prevalence rate was around 26 percent,” he said. “So when the rate is at 18 percent nationally at present, the farm average or on mines could be around 20 percent or slightly higher.”
One factor driving HIV and AIDS on farms, he noted, is risky sexual behaviour.

“It has been established that there is very high-risk sexual behaviour there, perhaps because farms are often isolated. So you find out that prostitution is a key source of entertainment despite the risks,” Mugurungi added.
Poverty is endemic. Farm labourers are Zimbabwe’s lowest paid workers, earning Zim $1.6 million (about US$50) per month – when there is work. 
In an economic environment where the prices of goods and services are continuously rising with inflation soaring at about 6,600 per cent, the money is only enough to buy three bars of laundry soap.

The government is well aware of the looming health crisis on the farms. In its HIV and AIDS Strategic Plan for 2006-2010, the government – supported by UNAIDS – identifies several immediate threats from the epidemic on the farm, including a weakened labour force, lower agricultural productivity and reduced food security.

“Agricultural practices will be reviewed in the light of a weakened labour force and the increasing number of households that are unable to feed themselves using traditional farming methods. Modified less labour intensive methods will be promulgated as needed,” the document says.

A trade unionist representing farm labourers suggested that poverty was driving female workers to engage in sex work to supplement their low incomes, exposing them to abuse.

Getrude Hambira, secretary general of the General Agricultural and Plantation Workers of Zimbabwe (GAPWUZ), wants the government to revive a pre-land reforms programme in which government-trained farm health workers helped identify and administer basic treatment for sexually transmitted diseases.

However, following the land reforms programme, the scheme was abandoned. This has left a huge gap, as there are few or no health facilities on most farms.

“If the HIV and AIDS crisis on farms is left unchecked, there could be a serious labour shortage in the country,” Hambira warned. – 2010 Features

Editor: Thulani Mpofu is a Zimbabwean freelance writer.

By Adetoun Sodimu, R N, BA/Maryland

 As a Caregiver, one of the greatest priorities is to get patient and/or Caregiver buy-in into the Plan of Care for a favorable outcome. Health maintenance outside of the hospital setting depends on patient’s actions in maintaining optimum health and preventing illnesses and medication compliance is a big part of this, because this is one of the major areas that patients usually function independently, and this in itself has a lot of challenges with any population, especially the African population.

Many Africans seem to shy away from medical interventions possibly for traditional or spiritual reasons, but one thing we need to keep in mind is that our physical bodies like any other equipment, needs to be maintained and/or repaired, and doing this does not make us any less spiritual or traditional, simply human.

Case in point, my Mom, an educated, retired teacher now resides in the US permanently, and it is a difficult feat to get her to be in compliance with her prescribed medication regimen after explaining the rationales and outcomes albeit favorable ones. She listens patiently and even agrees with me, only to mention some bothersome symptoms in passing a few weeks later resulting from the fact that she has not been taking her medications as prescribed. She believes strongly in the power of the Blood of Jesus, which is quite true, however I have explained to her on numerous occasions, that God gave us this physical body with its anatomy and physiology and that we need to maintain this through prevention and treatment, and that God would not hold it against her if she takes the prescribed Cardiac medications to enhance the function of an aging heart and body. I have since assured her that her soul is intact, and I’m glad to say we are making slow, but sure progress in that regard.

Another of my relatives on the other hand is the exact opposite she will take any and every medication she lays her sights upon, including fertility medication even though she is way beyond the child bearing age, so we also need to educate our loved ones about taking just any medications. We cannot recover our youthful bodies by taking medications, we simply have  

to preserve what we already have.

Also a lot of us have this uncanny ability to self diagnose ourselves and our loved ones and we do not hesitate to provide medications to back up these diagnosis, especially antibiotics, which there seems to be an endless supply of. It is not only unwise to do this it can be dangerous as these also can have extremely dangerous repercussions, including liver and kidney damage or even death, so we need to caution ourselves and our home grown physicians and prescribers to be careful at dispensing medical advise as well as medications.

 But back to medications; why must I take them you ask, they are so expensive? Yes, but there is always a way out.

First of all as earlier explained we need to keep our bodies going while we are alive afterall no one can live well in poor health, so a pill here and there prescribed is not only necessary but it is imperative when prescribed to improve or maintain an acceptable quality of life. Also most of us do not have access to the Herbs, leaves and tree barks that our grandparents used in those days, but my take on this is that today’s medications are an improved version of those very same herbs, which when taken correctly will have the desired and similar effects.

Look at it like this non-compliance can have disastrous ramifications because there is the likelihood of the condition getting worse or even resulting in emergency room visits or have fatal results.

About the cost! There are many programs available even Medicare has added a Part D for medication Benefits there are websites for people with chronic illnesses that provide support and links for means of getting medication benefits, even as the good book states in James 4:2 warns us that “we have not because we ask not.” See, we need to seek to find and ask in order to get. So there…

 As the old adage goes, “a word is sufficient for the wise.” I cannot reiterate the importance of Medication Compliance for every one, young and old alike. Remember that ignorance is really NOT bliss. You have been told…. Will write to you again soon.

 If you have any questions about links to obtaining medication & medication benefits.  Please feel free to contact the writer at toun_sodimu@hotmail.com